Editor’s Note: This article is written by Rebecca Talkin, an EPX independent researcher and a second year medical student at Saint Louis University School of Medicine. Rebecca has been working in the past year with the Bridgeway Behavioral Health group, to utilize the EpxSubstanceUse intervention in helping patients struggling with substance use.
As many of you have heard, a heroin epidemic is plaguing the American Northeast. It is estimated that approximately 8% of the general adult population in the USA suffers from a substance use disorder (SUD). This can include illicit drugs or more common substances, including alcohol and tobacco. Psychosocial treatments, including cognitive behavioral therapy, motivational interviewing, and peer support groups are the first line of defense for patients suffering from alcohol and substance use disorders. However, 50-90% of people relapse after a period of recovery.
After making it past the most difficult hurdles of overcoming a substance use disorder (acknowledgement and actively seeking treatment), it is frustrating that in the final stretch of recovery a majority of patients relapse. The reality is, recovering from addiction is a lifelong commitment. Having a tool to help patients get past the most vulnerable periods of recovery, can help patients achieve abstinence lifelong.
The A-CHESS mobile application from University of Wisconsin – Madison provides evidence that technology-based interventions can be helpful in reducing relapse in substance use disorder patients. This application provides extended skills training over time based on a client’s current needs and a panic button for high-risk situations. It was shown to significantly reduce the number of risky drinking days and increase the number of abstinent days over the 8 months following inpatient alcohol treatment. However, digital health technologies such as computer-based interventions without provider accountability or proactive alerts have extremely high attrition rates.
So, why use text?
Epharmix uses text messages to meet the population where they are. We believe that an Epharmix intervention can be effective in helping to maintain abstinence for those who are in recovery from substance use by directly reaching out to the patient so that they do not have to access the application themselves. Substance use is an issue that can often be overlooked by physicians and caretakers, especially in those patients who are dealing with other health issues. However, substance use management should be a priority in patient care as it can have serious affects on overall physical and mental health. By monitoring substance use and vulnerability to substance use in patients recovering from addiction, EpxSubstanceUse can keep both providers and patients focused on recovery goals and long-term abstinence.
What to ask?
Initial options explored following when patients were hungry, sleepy, or lonely, but our pilot with Bridgeway Behavioral Health showed that those measures did not correlate with substance use. Instead, the pilot did show that the intervention has great potential for patients in substance use recovery, with an 80% overall response rate and an average response of 6/9 when asked whether they thought the intervention was helpful in preventing relapse.
One of the beauties of working with a company like Epharmix is we have ample chance to iterate. In an attempt to make the intervention more universal and predictive of the outcome of decreasing substance use for patients in recovery, we are developing a new intervention that more directly asks people whether or not they have slipped. This new intervention has an option to send messages every other day or once a week depending on the setting the care provider chooses. This allows the provider to receive constant information about whether a patient has slipped or not and whether a patient feels likely to slip. Alerts are sent to the provider when a patient has slipped or if they are above a set threshold for how close they feel to slipping. Our new intervention also will provide personalized, positive feedback to patients for remaining abstinent for certain time intervals. Additionally, it will provide a phone number as a resource for patients to contact when they feel at risk for using and give the providers the opportunity to contact patients when they have slipped or report feeling close to slipping.
Thanks to a grant from SAMHSA, Epharmix has the opportunity to test this intervention with the Behavioral Health Network, a collaborative effort of providers and other organizations dedicated to developing accessible behavioral healthcare for uninsured and underinsured citizens. We are excited to get this new intervention out into the community, as an opportunity for those recovering from substance abuse to have a new support system at their fingertips. Just as a traditional sponsor is devoted to keep sponsees on track and be available in the most vulnerable times, the Epharmix Substance Use system will consistently keep track of abstinence, provide encouragement, and act as bridge between the patient and the provider whenever additional support is needed. We rely on our cell phones for nearly everything: from deciding where to eat, what to listen to, and how to get places. With technology so integrated into our daily lives, I am confident that people can comfortably rely on the substance use intervention to help them to achieve lifelong abstinence from substance use.
- Gustafson DH, Boyle MG, Shaw BR, et al. An e-health solution for people with alcohol problems.Alcohol Research & Health. 2011;33(4):327–337
- Muench F. The Promises and Pitfalls of Digital Technology in Its Application to Alcohol Treatment. Alcohol Research : Current Reviews. 2014;36(1):131-142.